As government shutdown looms, Obamacare exchanges still set for launch

The 34 exchanges, being run all or in part by the federal government, will also be up and running Oct. 1, although only mandatory funding or funds already appropriated through the ACA can be used to keep them staffed and running. Such money is available to several HHS agencies, including the Centers for Medicare & Medicaid Services, which is in charge of implementing Obamacare.

“Several HHS agencies have substantial mandatory, carryover or user fee funds which are not affected by a hiatus in annual appropriations, with CMS having the most mandatory funds,” the HHS shutdown contingency plan states.

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Will everything run smoothly?

Not likely. The exchanges are already facing other delays and glitches even without the complications of a government shutdown. How quickly officials can troubleshoot and fix the widely expected snags and glitches in a shutdown scenario isn’t totally clear.

Just last week, HHS announced that the small-business health exchanges run by the feds will have to delay online enrollment until November. And the District of Columbia health exchange announced that it won’t be able to calculate people’s eligibility for subsidies and Medicaid online right away because of a “high error rate” discovered during the testing.

There have been reports of other problems, as well — The Wall Street Journal reported that the software used to calculate the subsidized prices of health coverage in the federal exchanges wasn’t working right as recently as two weeks ago.

That doesn’t mean they won’t be able to open and start signing people up — and the coverage won’t start until Jan. 1, anyway. But it was never going to be a smooth ride, and the strain on HHS — with those widespread furloughs in other agencies — could still affect the exchanges in ways that won’t be clear until Tuesday.

What will we see?

People who are not deterred by the shutdown and want to sign up for coverage online will see big differences in the website features of the states that are running the exchanges on their own. California, for instance, will look a bit different from Maryland.

But in the 34 states where the exchanges are totally or partly run by the federal government, the websites are likely to look more similar. Each state will have some of its own basic branding, but there will be a standard design for the rest, according to experts who have been consulting with state and federal officials.

But in each one, consumers will be able to compare the prices of health plans with different levels of coverage — bronze, silver, gold and, in some cases, platinum. They should also be able to find out whether they qualify for the tax credits that can help bring down the so-called sticker price. Those will be available on a sliding scale for people who earn up to 400 percent of the federal poverty level — currently $45,960 for an individual and $92,200 for a family of four.

And ultimately, they should be able to enroll online. The key question, though, is whether all of those features will work or whether websites will crash or give incorrect answers. And given the track record so far, there are sure to be problems — but whether they’re trivial won’t be known in full until Tuesday.

How long can the exchanges stay open in a shutdown?

The longest U.S. government shutdown lasted around two weeks — so based on history, a shutdown isn’t likely to last long.

But even if a shutdown does last for months, the exchanges will probably remain up and running — although the federally run exchanges could suffer under staff furloughs.

It seems clear that the insurance subsidies — awarded in the form of tax credits — must continue no matter what. That’s what the CRS report concluded. “The funds for such credits would continue to be available via this permanent appropriation during a government shutdown,” CRS wrote.

And because the exchanges are the venue for determining eligibility for subsidies and delivering them, they’d probably have to keep running, as well.

“It may be likely that at least some of the eligibility and processing functions associated with the payment of this credit might continue during a government shutdown,” the report said.

But staffing problems could arise in a long shutdown since agencies are required to furlough all employees deemed nonessential. The diminished workforce could make it harder to make sure the exchanges are operating in the long term.

Furloughs could also affect the state-run exchanges since they’ll still depend on the federal government to help deliver eligibility information. But the effects would probably be less severe because state-run exchanges have to wean themselves from federal operational funds by 2015, when they’re required to become self-sustaining.